MS-DRG 115 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Diseases & Disorders of the Eye |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 115 by major payers:
$16,600.73
$20,365.05
$24,044.34
$24,921.71
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for MS-DRG 115 | ||||||
United | 115 | $11932.53 | 1508934217 - MARSHALL MEDICAL CENTER NORTH | 831651180 | AL | General Acute Care Hospital (282N00000X) |
United | 115 | $49374.75 | 1104845015 - TEXAS HEALTH HARRIS METHODIST HOSPITAL HURST-EULESS-BEDFORD | 751438726 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL HURST-EULESS-BEDFORD | TX | General Acute Care Hospital (282N00000X) |
United | 115 | $19467.26 | 1669752234 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 115 | $18247.42 | 1326064452 - SOLIS HEALTHCARE, LP, ROXBOROUGH MEMORIAL HOSPITAL | 454246163 - (PA) PRIME HEALTHCARE SERVICES ROXBOROUGH, LLC | PA | Psychiatric Hospital Unit (273R00000X) |
United | 115 | $35621.78 | 1760446256 - ALLINA HEALTH SYSTEM, ABBOTT NORTHWESTERN HOSPITAL | 363261413 - ALLINA HEALTH SYSTEM | MN | General Acute Care Hospital (282N00000X) |
United | 115 | $29571.84 | 1912108002 - MISSION HOSPITAL REGIONAL MEDICAL CENTER, PROVIDENCE MISSION HOSPITAL | 951643360 - (CA) MISSION HOSPITAL REGIONAL MEDICAL CENTER | CA | General Acute Care Hospital (282N00000X) |
United | 115 | $28622.25 | 1376214981 - FRANCISCAN HEALTH INDIANAPOLIS & MOORESVILLE, FRANCISCAN HEALTH ORTHOPEDIC HOSPITAL - CARMEL | 350913537 | IN | Special Hospital (284300000X) |
United | 115 | $50314.10 | 1164529400 - VALLEY BAPTIST MEDICAL CENTER | 452662980 | TX | General Acute Care Hospital (282N00000X) |
United | 115 | $10799.61 | 1306893268 - NORTHWEST MEDICAL CENTER ASSOCIATION INC, MOSAIC MEDICAL CENTER ALBANY | 440580870 - NORTHWEST MEDICAL CENTER ASSOCIATION INC | MO | Critical Access Hospital (282NC0060X) |
United | 115 | $15132.38 | 1295764553 - PREFERRED HOSPITAL LEASING ELDORADO, INC., SCHLEICHER COUNTY MEDICAL CENTER | 203662596 - (TX) PREFERRED HOSPITAL LEASING ELDORADO INC | TX | Critical Access Hospital (282NC0060X) |
United | 115 | $25765.46 | 1255377149 - OHIOHEALTH CORPORATION, GRANT MEDICAL CENTER | 314394942 - OHIOHEALTH CORPORATION GRANT RIVERSIDE DOCTORS DUBLIN MET | OH | General Acute Care Hospital (282N00000X) |
United | 115 | $1829.00 | 1073647384 - NATCHITOCHES PARISH HOSPITAL SERVICE DISTRICT, NATCHITOCHES REGIONAL MEDICAL CENTER | 726013916 - (LA) NATCHITOCHES REGIONAL MEDICAL CENTER | LA | Medicare Defined Swing Bed Hospital Unit (275N00000X) |
United | 115 | $45011.39 | 1104845015 - TEXAS HEALTH HARRIS METHODIST HOSPITAL HURST-EULESS-BEDFORD | 751438726 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL HURST-EULESS-BEDFORD | TX | General Acute Care Hospital (282N00000X) |
United | 115 | $30811.91 | 1063443455 - INDIANA UNIVERSITY HEALTH WEST HOSPITAL INC, IU HEALTH WEST HOSPITAL | 351814660 - (IN) INDIANA UNIVERSITY HEALTH WEST HOSPITAL INC | IN | General Acute Care Hospital (282N00000X) |
United | 115 | $21654.76 | 1699777458 - SAINT MICHAEL'S MEDICAL CENTER, INC., SAINT MICHAEL'S MEDICAL CENTER | 463487442 | NJ | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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MS-DRG 115 vs. Other Diseases & Disorders of the Eye Codes
The MS-DRG 115 code is part of the Diseases & Disorders of the Eye services . It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The MS-DRG 115 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 114-APR-DRG | High | DENTAL DISEASES & DISORDERS |
| 114-MS-DRG | High | Orbital Procedures without CC/MCC |
| 115-MS-DRG | High | Extraocular Procedures except Orbit |
| 116-APR-DRG | Moderate | Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 115. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 115 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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